427. Clostridium difficile Infection (CDI), Mortality, and Hospital Utilization after Hematopoietic Stem Cell Transplantation (HSCT)
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Incidence and severity of CDI are increasing. This study aimed to determine whether CDI is associated with survival, graft versus host disease (GVHD), and inpatient hospital utilization.
Methods: 110 HSCT patient charts were reviewed for CDI diagnosis, GVHD, hospitalizations, and death.
Results: 33 patients had CDI in the one year post-HSCT (30%). Mean survival in CDI positive cases was 454 days (95% CI 319-589) and in CDI negative cases was 606 days (95% CI 548-684). By day +365, 16 of 33 CDI positive cases had died and 22 of 77 CDI negative cases had died (Fisher’s Exact Test, p = 0.05). Uni-variate analysis revealed that CDI (p = 0.05), acute leukemia (p = 0.007), allogeneic donor (p = 0.0006), and t-cell depletion (p = 0.002) predicted death at day +365. Chronic GVHD tended towards significance (p = 0.15). In a multivariate model, chronic GVHD and donor remained significant predictors of death.
Acute GVHD developed in 11 of 33 CDI positive cases and 16 of 77 CDI negative cases (p = 0.22). Chronic GVHD developed in 8 of 33 CDI positive cases and 16 of 77 CDI negative cases (p = 0.63). In 9 of 11 CDI patients with acute GVHD, CDI predated acute GVHD onset. In all 8 CDI patients with chronic GVHD, CDI predated chronic GVHD onset.
Mean inpatient hospital days was 57 (95% CI 45-69, range 19 to 161) in the CDI positive cases and 47 (95% CI 40-54, range 10-177) in the CDI negative cases (p = 0.21).
Discussion: Un-adjusted survival of CDI positive cases at day +365 was significantly lower than survival of CDI negative cases. The development of GVHD followed CDI in almost all instances. This time course is interesting and should be prospectively evaluated. Despite increased mortality, utilization of hospital days did not differ between the CDI positive and negative cohorts.
C Bertozzi-Villa, Undergraduate1, K Mullane, DO2, D Pitrak, MD2, Kenneth Pursell, MD, C Ramaprasad, MD, MPH2, K Van Besien, MD2, Stephen G. Weber, MD, MS2 and  C. Ramaprasad, None..
C. Bertozzi-Villa, None..
S. G. Weber, None..
D. Pitrak, None..
K. Mullane, None..
K. Van Besien, None..
K. Pursell, None., (1)The University of Chicago Medical Center, Chiago, IL, (2)The University of Chicago Medical Center, Chicago, IL